Drive systems and methods of use

ABSTRACT

Drive systems and methods of use are disclosed herein for performing medical procedures on a patient. The drive systems include various handle types and triggers for controlling catheters and end effectors. The various handle types include a flexible handle and ambidextrous handles that can alter the handedness of the handle for particularized use. The handles drive articulation sections of the catheter and end effectors with various degrees of freedom, and include locks for holding the catheter and/or end effector in place. The catheter systems include structures for allowing degrees of freedom, such as notches, mechanical interlocks, and articulation joints. In addition, the catheters articulate via cables or fluids.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/008,502, filed on Jan. 11, 2008, which claims priority to U.S.Provisional Application No. 60/938,924 entitled “Drive Systems andMethods of Use,” filed on May 18, 2007, both of which are incorporatedherein by reference in their entireties.

BACKGROUND OF THE INVENTION

Conventional surgical tools, such as endoscopic and laparoscopicdevices, can provide surgical access to surgical sites while minimizingpatient trauma. Although the growing capabilities of such therapeuticdevices allow users to perform an increasing variety of surgeriesthrough traditional minimally invasive routes, further refinements mayallow surgical access through even less invasive routes and/orfacilitate conventional surgical procedures. Currently some roboticsystems have been proposed to allow surgical access via a naturalorifice. The user interface is remote from surgical tools and/or endeffectors. Unfortunately, these systems are generally expensive andcomplicated. In addition, they fail to provide the tactile user feedbackthat traditional devices can provide.

Accordingly, there is room for further refinement to surgical devicesand a need to develop new surgical systems.

SUMMARY

An embodiment includes a tool for use in performing medical procedureson a patient. The tool can include various novel handle types andtriggers for controlling a catheter and/or end effector. In oneembodiment, a control member (or control handle) allows a user tocontrol one, two, three, four, five, six, or more than six degrees offreedom. The control handle controls degrees of freedom via a bendableshaft in one embodiment.

The handle also provides for ambidextrous use in an embodiment. The usercan change the handedness of the handle and/or stand the handle on itsend in a joystick configuration for a particularized use. These handlescan also change orientation in other ways. By manipulating handleorientation, a user can more easily articulate a catheter and/or actuatean end effector.

In one embodiment, catheter articulation is accomplished by creatingtension along cables via a spring-loaded pin, while, in anotherembodiment, the spring-loaded pin is absent. In still anotherembodiment, fluid pathways, instead of cables, articulate thearticulation section of a catheter. The articulation section can lockinto a particular position or shape in at least one embodiment.

The articulation section of a catheter can include notches to allowarticulation. In another embodiment, the articulation section includesball sockets. In still another embodiment, articulation jointsfacilitate the catheter articulation.

Additional objects and advantages of the embodiments will be set forthin part in the description which follows, and in part will be obviousfrom the description, or may be learned by practice of the embodiments.The objects and advantages of the embodiments will be realized andattained by means of the elements and combinations particularly pointedout in the appended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the embodiments, as claimed.

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate several embodiments and togetherwith the description, serve to explain the principles of theembodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate several embodiments and togetherwith the description, serve to explain the principles of theembodiments.

FIG. 1 is an exemplary perspective view of a tool comprising a controlmember, catheter, and end effector, in accordance with an embodiment.

FIG. 2A is an exemplary illustration of inner components of a tool, inaccordance with an embodiment.

FIG. 2B is an exemplary illustration of tool components in accordancewith an embodiment.

FIGS. 2C and 2D are exemplary illustrations of a trunnion within acontrol member, in accordance with an embodiment.

FIG. 2E is an exemplary illustration of a trunnion with a double-pulleysystem and a control stem in a neutral position, in accordance with anembodiment.

FIG. 2F is an exemplary illustration of a trunnion with a double-pulleysystem and a control stem turning clockwise, in accordance with anembodiment.

FIG. 2G is an exemplary illustration of trigger mechanism components inaccordance with an embodiment herein.

FIGS. 2H and 2I are exemplary illustrations of another trigger mechanismin accordance with an embodiment.

FIGS. 2J and 2K are exemplary illustrations of a “firewall” couplingmechanism for coupling the control member to one or more control cables.

FIG. 3 is an exemplary cross-section of the distal end of a controlmechanism with an adjuster, in accordance with an embodiment.

FIG. 4 is an exemplary illustration of a handle with a joystickconfiguration, in accordance with an embodiment.

FIG. 5 is an exemplary illustration of an alternative handleorientation, in accordance with an embodiment.

FIGS. 6A and 6B are exemplary illustrations of a handle with a flexibleshaft, in accordance with an embodiment.

FIGS. 7A through 7C are exemplary illustrations of another handle with aflexible shaft, incorporating a grip, in accordance with an embodiment

FIGS. 8A through 8D are exemplary illustrations of gears that permit auser to control degrees of freedom, in accordance with an embodiment.

FIGS. 9A through 9C are exemplary illustrations of an ambidextroushandle being changed from right-handedness to left-handedness bydetaching and flipping the handle, in accordance with an embodiment.

FIGS. 9D and 9E are exemplary illustrations of an ambidextrous controlhandle with a split grip being changed from right-handedness toleft-handedness by rotating the grip portions, in accordance with anembodiment.

FIG. 9F is an exemplary illustration of an ambidextrous handle that canchange handedness by rotating around an axis, in accordance with anembodiment.

FIG. 9G is an exemplary illustration of an ambidextrous control handlethat can be flipped in order to change handedness, in accordance with anembodiment.

FIG. 9H is an exemplary illustration of another ambidextrous controlhandle that can be flipped in order to change handedness, in accordancewith an embodiment.

FIGS. 9I through 9K are exemplary illustrations of ambidextrous handlesthat can also be changed into a joystick configuration, in accordancewith an embodiment.

FIG. 9L is an exemplary illustration of a handle that can change betweenjoystick configuration and side configuration, also including a rockermechanism, in accordance with an embodiment.

FIGS. 10A through 10C are exemplary illustrations of a catheter having acontinuous body section with cut-outs that allow for articulation, inaccordance with an embodiment.

FIGS. 11A through 11C are exemplary illustrations of a catheter havingmultiple articulating ball sockets, in accordance with an embodiment.

FIGS. 12A through 12G are exemplary illustrations of catheters havingadditional types of multiple articulating ball sockets, in accordancewith an embodiment.

FIGS. 13A through 13D are exemplary illustrations of catheters havingarticulation joints, in accordance with an embodiment.

FIGS. 14A through 14E are exemplary illustrations of a tool includinghydraulic control of the catheter, in accordance with an embodiment.

DESCRIPTION OF THE EMBODIMENTS

Described below are exemplary embodiments of tools that allow a user toperform a procedure, such as a surgical procedure, at a distance. In oneaspect, a tool generally includes a proximal user interface (referred toherein as a control member or handle), an elongate catheter body, and adistal end. The proximal control member can control movement of thecatheter and/or an end effector positioned proximate to the distal endof the tool. The tools described herein permit control of one, two,three, four, five, six, or more than six degrees of freedom via thehandle and/or control member.

In one embodiment, user input forces upon the handle can controlmovement of the handle relative to the control member and/or can controlmovement of the (entire) tool relative to a reference point (e.g.,relative to a patient). For example, movement of the handle can controlarticulation of a catheter articulation section and/or actuation of anend effector. In one aspect, movement of the handle can drive one, two,three, or more than three degrees of freedom of the catheter and/or endeffector. In another aspect, moving the control member (e.g., rotationaland/or longitudinal movement relative to a point of reference) cancontrol one, two, or more than two degrees of freedom.

The tools described herein can be used with a variety of surgical ornon-surgical system, including, for example, those described in U.S.patent application Ser. Nos. 11/946,779; 11/946,790; 11/946,799;11/946,807; 11/946,812; and 11/946,818, which are incorporated herein byreference.

While the discussion of devices, systems, and methods below maygenerally refer to “surgical tools,” “surgery,” or a “surgical site” forconvenience, the described devices, systems, and their methods of useare not limited to tissue resection and/or repair procedures. Inparticular, the described systems can be used for inspection anddiagnosis in addition, or as an alternative, to surgery.

FIG. 1 illustrates one exemplary embodiment of a tool 10 comprising acontrol member 20, catheter 22, and end effector 24. Control member 20is illustrated in more detail in FIGS. 2A through 2G and can include ahandle 26 that allows a user to control actuation of catheter 22 and atrigger 28 that allows a user to actuate the end effector.

In one embodiment, control member 20 includes a body 30 that houses acontrol mechanism for transferring user inputs on handle 26 to catheter22 and/or end effector 24. User input forces can be directed into pulland/or push forces on one or more control wires that extend between thecontrol mechanism and the catheter articulation section and/or endeffector. As used herein, “control cable” refers to the variousfilaments, wires, cables, Bowden cables (inner cable and/or outersheath) which can transmit user inputs between the control mechanism andthe distal portion of the catheter. Descriptions of exemplary cables,catheters, and end effector are disclosed below and in the abovereferenced U.S. Patent Applications.

Described below and illustrated in FIGS. 2A through 2G are variousexemplary control mechanisms. In one aspect, user inputs to the handlecan rotate or pivot at least a portion of the control mechanism.Rotation around a first axis can control one degree of movement of thecatheter and rotation around a second axis can control a second degreeof freedom. Tool 10 can also, or alternatively, include a triggermechanism for driving an additional degree of freedom. In one aspect,the trigger mechanism is position, at least partially, on or in thehandle of tool 10. As used herein, the term “trigger mechanism” canrefer to the variety of switches, buttons, rockers, and/or other suchfeatures for mechanically or hydraulically driving a degree of freedom,such as, for example, movement of the end effector.

As shown in FIGS. 2A and 2B, handle 26 can be rotatably coupled to thebody of control member 20 having a longitudinal axis C-C such that thehandle is able to move forward and aft. In one aspect, the handlerotatably couples with side rails 310 a and 310 b to rotate about axisB-B. The rails are included as part of the housing and/or frame in oneembodiment. In addition, handle 26 can rotate about an axis, such as,for example, an axis A-A defined by or parallel with shaft 320. Movementof the handle back and forth during rotation about axis B-B can causethe distal tip of the tool 10 to move in one plane (e.g., a plane xzcontaining axis A-A and axis C-C) while rotation of handle 26 about thelongitudinal axis A-A of the shaft 320 can cause movement of the distaltip of the tool 10 in another plane (e.g., a plane xy containing axisB-B and axis C-C).

The handle can be secured to side rails 310 a and 310 b with a trunnion316. Trunnion 316 includes a pair of outwardly extending posts 318 a,318 b that fit in corresponding holes formed in side rails 310 a, 310 b.The connection between the posts and side rails can allow movement ofthe trunnion within the control member. In one aspect, a matingmechanism such as, for example, a snap ring or other fastener can secureposts 318 a, 318 b into the side rails. Alternatively, or additionally,the post can be secured by sandwiching between the side rails.

Forward/aft movement of the handle can pivot trunnion 316, for example,around an axis B-B extending through posts 318 a, 318 b. The trunnioncan mate with control cables such that pivoting the trunnion applies forto one or more control cables and drives at least one degree of freedom.The trunnion can include a pair of cable receivers 356, 358 having aslot or other receptacle therein that secures an end of an articulationcable. As shown in FIGS. 2C and 2D, one of the cable receivers 358 isbelow the pivot point of trunnion 316, and the other is above the pivotpoint. Upon tilting trunnion 316 in the control member, the cablereceivers 356, 358 selectively tension or release control cables thatmove the distal tip of tool 10.

FIGS. 2C and 2D illustrate further detail of trunnion 316. The controlmechanism can include a stop to limit the amount of forward and aftmovement of the handle 26. In one aspect, a ring 340 fits over the postsof trunnion 316 and has a notch 342 therein. A pin 344 secured in theside rail (not shown) limits how far the handle can travel by engagingthe ends of the notch 342. Other structures besides pins can also beused. While the FIGS. illustrate a ring/pin configuration, one skilledin the art will appreciate that a variety of alternative mechanisms canbe used to limit motion of the cable guide plate. In addition, theillustrated configuration could be reversed such that the notch could belocated on the side rail and the pin could be located on the trunnion.

Trunnion 316 can further includes an opening or slot in which a cableguide plate or disk 328 is located. In the illustrated embodiment ofFIGS. 2B, 2C, and 2D, cable guide plate 328 is generally circular andmates with at least one control cable. In one aspect, guide plate 328includes a groove 330 therein in which control cable 332 c is fitted. Inaddition, cable guide plate 328 can include a notch 334 a that receivesa corresponding cable stop 336 that is secured to cable 332 c (while asingle notch/stop/cable is illustrated, additional notches, stops,and/or cables are contemplated). Movement of the cable guide platecauses corresponding tension or relaxing of cable 332 c.

The cable guide plate 328 can be fitted into a slot within the trunnionsuch that it lies behind the stop plate 326. In one aspect, the shaft320 fits through a corresponding hole in the cable guide plate 328 and asnap ring or other fastening mechanism secures the components together.Rotation of the handle 26 causes a corresponding rotation of the shaft320 which in turn is coupled to the cable guide plate 328 to tension orrelease cable 332 c.

Cable 332 is illustrated as wrapped around disk 328 more than 360degrees. In another aspect, cable 332 can be wrapped around the diskmore than about 180 degrees, and in another aspect more than about 270degrees. In yet another aspect, cable 332 mates to disk 328 withoutwrapping around a portion of the disc. In embodiments where the controlmechanism includes a force limiter, the cable may also attach to theforce limiter.

While a single cable 332 c is illustrated as mated with disk 328, inanother embodiment two control cables can mate with the disk. Rotationin a first direction can tension one of the two cables, while rotationin the other direction tensions the other of the two cables.

In one aspect, trunnion 316 further includes a stop plate 326 thatprovides an anchor for the ends of control cable sheaths 332 a, 332 b,or more particularly, the sheaths of bowden cables. Control cable 332 a,mated with disk 328, can extend through bowden cable sheaths 332 a, 332b. The stop plate 326 pivots up and down with the trunnion 316 as thehandle 26 is moved forward and aft. The bowden cables can permit thetrunnion to pivot around posts 316 a, 316 b (controlling one degree offreedom) without (or with minimal) effect on control cable 332 a (whichcontrols a different degree of freedom).

Also shown in FIGS. 2C and 2D is a control cable 346 that is actuated bythe trigger mechanism 28 on the handle. Depressing trigger 28 causes atensioning of the cable 346 to actuate, for example, an end effector 24at the distal end of the tool. In the illustrated embodiment, cable 346is a bowden-type cable having an outer sheath 348 with one end securedto a cable stop 350 positioned on the, shaft 320 (or collar 324, orhandle 26). The cable is not exposed outside the handle in oneembodiment. The other end of the bowden cable housing extends through across bar 354 and joins a stop at the distal end of the catheter. Thecrossbar 354 also includes stops for the bowden cable housings 332 a,332 b that are driven by rotation of the handle as described above.

FIGS. 2E and 2F illustrate a trunnion with a dual pulley (or dual disk)system that serves as an-alternate embodiment to the single-pulleysystem previously described. As used herein, the pulley or disk cancomprise a rotating mechanism and is not limited to a circular member.As the tool handle is rotated in a first and second direction, thedouble-pulley configuration can apply a pulling force on control wire332 a or 332 a′ without pushing on the other of control wires 332 a, 332a′. A top pulley 335 a corresponds to first cable 332 a, and a bottompulley 335 b corresponds to cable 332 b. Each pulley contains only onecontrol cable 332 d and 332 e. Typically, the two pulleys 332 a and 332b are stacked on top of one another, separated by a frictionless washer,such as a piece of Teflon™.

A top pin 337 a drives the top pulley 335 a, while a bottom pin (notshown) drives the bottom pulley 335 b. Unlike the single-pulleyembodiment, the top and bottom pulleys each include a rut 334 b, suchthat the respective pin 337 a can rotate freely in the rut 334 b withoutdriving the respective pulley. Although referred to herein as pins, boththe top pin 337 a and bottom pin (not pictured) can have other shapes,such as a protrusion with a flat surface for engaging the stop.

FIG. 2E illustrates a double-pulley trunnion with the control stem 320in a neutral position. In this position, a counterclockwise turn of thecontrol stem 320 will engage the top pin 337 a with the stop of toppulley 335 a. As a result, top pulley 335 a pulls on first cable 332 a,and the distal portion of the catheter bends. However, the bottom pin(not shown) swings in the rut of the bottom pulley 335 b, and does notforce bottom pulley 335 b to rotate.

Conversely, FIG. 2F illustrates the double pulley interaction when thecontrol stem 320 rotates clockwise. The top pin 337 a rotates in rut 334b, and consequently does not push or pull first cable 332 a. On theother hand, the bottom pin engages the stop of the bottom pulley 335 b,and the bottom pulley 335 b rotates clockwise. This rotation appliestension to the right wire, which is pulled towards the bottom pulley 335b.

As a result, neither wire 332 a gets forcefully pushed out by the top orbottom pulleys 335 a and 335 b. Instead, the pulleys only pull on theirrespective wires. However, in one embodiment, the wires are free to moveback to respond to other tensions applied on the catheter.

Further detail of one embodiment of a trigger mechanism 28 is shown inFIG. 2G. In the illustrated embodiment, the trigger 28 is rotatablyreceived within the handle 26 such that squeezing the trigger 28 causesit to rotate about a, pivot point. The trigger 28 includes an arm 360 towhich an end of the actuation cable 346 is secured. As the arm 360 ismoved by pressing the trigger, tension on the control cable 346 isincreased to actuate the end effector. A roller or pulley 362 changesthe direction of the control cable 346 from within the handle to adirection that extends along the shaft 320.

FIGS. 2H and 2I illustrate another embodiment of a trigger mechanismthat includes a button 366 for activating the distal end of tool 10. Abowden cable 368 can extend into handle 26 to trigger mechanism 370. Thesecond end of the outer sheath 372 of the bowden cable extends inclearance through crossbar 354 and through the body of surgical toolwhere it terminates proximate to end effector. The outer sheath 372 ofthe bowden cable 368 can mate with a stop 374 in the trigger mechanismwhile the inner filament 376 extends into trigger mechanism 370. Whenbutton 366 is depressed, trigger mechanism 370 tensions inner filament376. In one aspect, trigger mechanism 370 include a ratchet-type lockthat prevents the release of inner filament 376 once tensioned. A button378 can be depressed to release inner filament 376 and allow the distalend of tool 10 to return to its original configuration.

FIGS. 2J and 2K illustrate one embodiment of a coupling mechanism thatcan be used to selectively couple the control member 20 to one or morecontrol wires (i.e., control cables) within the tool 10 (e.g., withincatheter 22). The coupler 380 forms an end-wall that is positionedwithin the actuator housing between the support rails 310 a, 310 b. Thecoupler 380 has a number of spring loaded pins 382 a, 382 b, 382 c,etc., positioned therethrough. Each of the pins 382 a, 382 b, 382 c,etc., is connected to a control cable that is moved by the handle 26 orthe trigger mechanisms as described above. Each pin includes a cablereceiving notch 384 therein that receives the ball or stop at the end ofa corresponding control cable 386 a, 386 b, 386 c, etc. for the medicaldevice. Secured by a cable terminal in the slots 384, each pin allowsthe tensioning or release of the corresponding cables 386 a, 386 b, 386c, etc. In the embodiment shown, each of the pins 382 a, 382 b, 382 c,etc. includes a spring 388 a, 388 b, 388 c that biases the pin towardthe distal end of the control member 20. The springs 388 serve totension the control cables within the body of the control when not beingpulled by the actuator and biases the control handle to return to a homeposition.

To connect the cables of catheter 22 of tool 10 to the control member20, the terminal ends of each of the control cables 386 a, 386 b, 386 c,etc. are inserted into each of the cable receiving slots 384 of thecorresponding pins. Similarly, to disconnect the cable, the balls orcable ends are removed from the cable receiving slots 384. Uponcompletion of a procedure, the catheter can be uncoupled from thecontrol member 20, cleaned or sterilized for re-use or thrown away.

In one aspect, the various cables within control member 20 can beadjustably tensioned. For example, in one embodiment spring loaded pins382 can have a threaded connection with coupler 380 (additionaldisconnect configurations are described below). Rotating pins 382 canmove pins laterally to control the tension on control wires mated topins 382. For example, rotating the pins 382 can compress or relaxsprings 388 and adjust tension on the control wires.

In another embodiment, tool 10 does not include the coupler 380 or thespring and pin arrangement shown in FIG. 2J. In such an embodiment, thedisc 328 mates with one end of the control wire(s) while a catheterarticulation section and/or end effector mates with the other end of thecontrol wire(s). Removing the springs can increase the tactile feedbackand efficiency of the tool 10, because the user need not overcome thebias of the springs when controlling the tool 10.

Because the springs also return the catheter articulation to a homeposition (such as straight), a spring-less embodiment may not have thisfeature. However, for some procedures, it is preferable for the catheterand/or end effector to remain in a current position withoutautomatically returning to a home position. The ability to leave thetool 10 in a current position can free the user to perform another taskinstead of maintaining constant control over tool 10.

In accordance with this need, either type of tool 10 (springs or nosprings) can include a mechanism for locking the catheter and/or endeffector into place. One such mechanism includes a pawl that interlockswith teeth to stop actuation. In one aspect, the user can lock andunlock the actuation by manipulating a button, slide, or triggermechanism that engages and disengages the pawl with the teeth.

The location of the pawl and teeth can vary, depending on the type ofactuation it controls. For example, a handle 26 can be locked byproviding a locking mechanism for the stem. A locking mechanism on thetrigger, push-pull mechanism, etc. can lock the end effector in place.This can allow the user to position and lock a clamp in place for theduration of some other step of the procedure.

In another embodiment of control mechanism 20, tool 10 can include aorientation adjuster. In use, the orientation adjuster can allow a userto rotate the elongate body and distal end of a tool relative to controlmechanism 20. FIG. 3 illustrates a cross-section of the distal end ofcontrol mechanism 20 with adjuster 394. Adjuster 394, in one aspect, caninclude an inner member 392 having a passageway 390. The passageway 390can mate with the elongate body (not illustrated) of catheter 22. In oneembodiment, the elongate body of catheter 22 includes an outer sheaththat fixedly mates to the inner surface of passageway 390. One skilledin the art will appreciate that a variety of mating mechanisms, such as,for example an adhesive, mechanical interlock, and/or frictionalengagement can be used. In addition, the inner member 392 can mate withthe inner surface of adjuster 394. For example, as illustrated in FIG.3, adjuster 394 includes an aperture 396 for a set screw for matingadjuster and inner member 392. In another aspect, adjuster and 394 andinner member 392 can be fixedly mate via, for-example, an-adhesive. Inaddition, the adjuster and the inner member can be formed as a singlebody.

To change the rotational orientation of catheter 22, adjuster 394 can berotated within control member 20. In one aspect, a locking collar 395can be tensioned to control the amount of friction between the controlmember and orientation adjuster 394. For example, the locking collar 395can be set to inhibit, but not prevent rotation of the adjuster, or setto prevent rotation until adjustment is desired. Since adjuster 394 ismated to inner member 392, and inner member 392 is mated to the body ofcatheter 22, rotating adjuster 394 causes catheter 22 to rotate relativeto control member 20.

Alternate Handle Configurations

Described below are alternative control mechanisms for actuatingcatheter 22 and/or end effector 24. FIG. 4 illustrates handle 261 havinga “joystick” configuration. In general, a handle in joystickconfiguration stands on its end rather than on its side. In one aspect,the control member can include a trunnion-type configuration as describeabove, that provides at least one degree of freedom to handle 261.However, instead of the handle positioned orthogonally to shaft 320 asdescribed above, handle 261 can be parallel to the axis of shaft 320.For example, handle 261 can be co-linear with shaft 320.

Forward-aft movement of handle 261 can be achieved in a similar fashionto the trunnion and disk configuration discussed above. For example,control member 20 of FIG. 4 can include trunnion 316 that rotatablymates with side rails 310 a, 310 b and a base 317 that houses disk 328.Base 317 can mate with cables (not illustrated) to control one degree offreedom as handle 261 is moved forward-aft.

Disk 328 can reside in base 317 and movably mate therewith. Twisting orrotating handle 261 can rotate disk 328 to control another degree offreedom. For example, rotating handle 261 about its axis can directside-to-side movement of the catheter.

Handle 261 can also include a trigger 28 that controls, for example, athird degree of freedom. Actuating trigger 28, in one aspect, cancontrol distal end effector 24. The trigger mechanism within handle 261can have a configuration similar to the triggers discussed above. Thus,the control mechanism of FIG. 4 can work in a similar fashion to thecontrol members of FIGS. 2A through 3, but with handle 261 in adifferent orientation compared with handle 26.

FIG. 5 illustrates an alternative handle orientation. Rotating handle262 around its axis (axis A-A) can control one degree of freedom. Forexample, rotating the top surface of handle 262 away from the user canmove the distal tip of the catheter down and rotating the top surface ofhandle 262 toward the user can move the distal tip of the catheter up.Handle 262 can also be rotated around an axis, such as, for example, anaxis orthogonal to the longitudinal axis of the tool, to control anotherdegree of freedom. In one aspect, handle 262 can be rotated around axisB-B to control side-to-side movement of the distal end of the catheter.

In one aspect, actuation is achieved via a control mechanism similar tothose described above. FIG. 5 illustrates a trunnion and diskconfiguration similar to that of handles 26, 261 described above.Movement around axis B-B can rotate trunnion 316, while rotation ofhandle 262 around its axis can move disk 328. However, unlike themechanisms described above, handle 262 can drive disk 328 via a beltand/or chain drive. A pulley 50 a connected to handle 262 can drivepulley 50 b via belt 52. Pulley 50 b can mate with a shaft 54 thatextends to disk 328.

Rotation around axis B-B can be driven through a frame or shaft (notillustrated) extending between handle 262 and trunnion 316 to transferrotational force between the handle and trunnion. Rotational forces canadditionally, or alternatively, be applied on shaft 54 through the beltand pulley system.

In another embodiment, rotating the handle 262 around axis A-A actuatesan end effector. This is just one of various actuation members discussedherein.

FIGS. 6A and 6B illustrate handle 263 defined at least in part by aflexible shaft 60 that is articulated to control catheter 22. In oneaspect, bending shaft 60 up-down or left-right can control a degree offreedom. The distal end 62 of shaft 60 can mate with cables 61. Wheretwo degrees of freedom are controlled via movement of shaft 60, fourcables can mate with shaft 60 and extend along a path proximate to theouter surface of the shaft. Bending of the shaft can pull cables 61 byincreasing the length of one side of the shaft. As the length of shaft60 increases with bending, the cable adjacent to the lengthened side ispulled. While four cables and two degrees of freedom are illustrated inFIG. 6A, fewer cables and/or degrees of freedom could be provided.

In one aspect, shaft 60 allows a user to control two degrees of freedomat once. Bending the shaft outside of the forward-aft or side-to-sideplane (e.g., at a 45° angle to the forward-aft movement) can pull on twocontrol cables that control separate degrees of freedom. Thus, a singlemotion can of shaft 60 can control two degrees of freedomsimultaneously.

Shaft 60 is formed, in one aspect, is formed from a spring 65. As theshaft is bent, the coils along inside surface of the curve convergewhile on the opposite side of the shaft the coils move away from oneanother. Spring 65 can also provide a neutral bias such that when theshaft is released, the catheter returns to a “home” or linearconfiguration. One skilled in the art will appreciate that the forcerequired to bend the spring and the amount of bend can be chosen byvarying the spring materials, the spring wind, pre-compression, and/orthe spacing between coils.

Shaft 60 could additionally or alternatively be formed from an elastomicmaterial, such as flexible, compressible, resilient, and/or elasticmaterials that allow bending. In one aspect, shaft 60 is formed from aflexible polymer or elastomer, such as, for example, silicon. In anotheraspect, shaft 60 is formed from a series of wafers. Bending is achievedby expanding the distance between wafers along one side of the shaftand/or decreasing the distance between wafers on the opposite side ofthe shaft.

Shaft 60 can further comprise an outer sheath 63 that covers spring 65(or other material forming shaft 60) to provide a barrier between spring65 and a user's hand. In one aspect, sheath 63 can be formed ofstretchable or loose material to permit actuation of the shaft. Inaddition, or alternatively, sheath 63 can be formed of a lubriciousmaterial and/or include a lubricious coating to allow sheath 63 to slideover the outer surface of spring 65 as shaft 60 is bent.

The control member 20 can also include pulleys 64 which change thedirection of the cables and the force applied through the cables. In oneaspect, each cable corresponds to at least one pulley 64.

Handle 263 can, in one aspect, include a trigger, button, or finger loopto permit an additional degree of freedom. As illustrated in FIG. 6,handle 263 can include a finger loop 66 that is actuated by movementalong the axis of the shaft. Pushing loop 66 away from the shaft canactuate, for example, distal end effector 24. Alternatively, oradditionally, a user can move loop 66 toward shaft 60 to actuate the endeffector.

To increase user comfort, control member 20 can include an arm rest 68.A user can place his or her forearm in arm rest 68 while grabbing andactuating shaft 60. The arm rest 68 can also deliver and/or isolatecertain degrees of freedom of the control handle. For example, the tipmovement can be isolated versus the entire control movement in oneembodiment.

FIGS. 7A through 7C illustrate another exemplary embodiment of a handle264 incorporating a flexible shaft 60 extending between a proximal end100 and a distal end 102. However, instead of directly grasping flexibleshaft 60, handle 264 can include a grip 104 for a user interface. Grip104 can have a variety of configurations. In one embodiment, grip 104includes an aperture for receiving a portion of a user's hand. Inaddition, the inner surface of grip 104 can include a trigger 106 foractuating an additional degree of freedom.

In one aspect, the distal end of flexible shaft 60 remains stationarywhile the proximal end of shaft 60 is bent. In particular, shaft 60 canextend in a distal to proximal direction from control member 20 and/orcatheter 22 such that pulleys are not needed to change the direction ofthe control wires. In use, bending shaft 60 in one direction can movethe distal tip of the catheter in the opposite direction. For example,bending the shaft up can move the distal tip down and visa versa.However, control wires can be redirected or crossed if it is desired tochange the correspondence between handle 264 and the distal tip of thecatheter.

In another embodiment, instead of a flexible shaft, handle 265 can drivegears to control at least one degree of freedom. FIGS. 8A through 8Dillustrate gears that permit a user to control two degrees of freedom.Handle 265 can include a rigid shaft 70 extending between a proximal anddistal end 71, 73. In one aspect, shaft pivots around proximal housing75 proximate to proximal end 71. The proximal housing can include afirst set of teeth 72 (FIG. 8B) positioned on the proximal surfacethereof. Forward-aft movement cause teeth 72 to drive a gear 74 as thefirst set of teeth 72 mesh with a second set of teeth 76 on gear 74. Acontrol wire 61 a mated with gear 74 is then driven as gear 74 rotatesto control one degree of freedom.

To permit an addition degree of freedom, shaft 70 can be movedside-to-side. FIG. 7B illustrate proximal housing 75 mating with anddriving a control wire. Side-to-side movement of shaft 70 pivots housing75 which in turn drives a second control wire 61 b mated with thehousing. As the shaft moves side-to-side, the first and second set ofteeth 72, 76 can slide relative to one another. In one aspect, theproximal surface of shaft 70 has a semi-spherical shape such that as theshaft moves side-to-side, the first teeth do not loose contact with thesecond set of teeth.

In another aspect, instead of proximal housing mating with control wire61 b, a shaft 80 can include a surface for mating with and drivingcontrol wire 61 b. Proximal housing 75 can be anchored or supported viaa shaft 80 that extends through the proximal housing and through slots78 a, 78 b. Forward-aft movement of the shaft does not interfere withshaft 80 because slots 78 a, 78 b have an elongate shape that permitsshaft 80 to remain in place as housing 75 moves relative to shaft 80.Thus, forward-aft movement of housing 75 is independent from shaft 80(for at least some distance). However, side-to-side movement of shaft 70causes proximal housing 75 to rotate shaft 80 around an axis S-S (FIG.8C) and drive control wire 61 b mated with shaft 80. In particular, withrespect to FIG. 8B, the surface on which control wire 61 b rests can bedefined by a portion of proximal housing 75 or by a bulbous portion ofshaft 80.

Alternatively, or additionally, a third and fourth set of teeth withinhousing 75 can transmit side-to-side motion into push-pull motion on acontrol wire (e.g., control wire 61 b). For example, as illustrated inFIG. 7D, proximal housing 75 can includes a third set of teeth 82 thatmesh with a fourth set of teeth 84 on a second gear 85. As the proximalhousing 75 moves side-to-side, teeth 82 on the inner surface of housing75 drive teeth 84 on gear 85 causing gear 85 to rotate and drive controlwire 61 b (not illustrated). During forward-aft movement, the third andfourth sets of teeth 82, 84 can slide relative to one another withouttransmitting force therebetween to permit independent control of twodegrees of freedom.

These and other handle embodiments can be oriented ergonomically forgreater comfort and usability. For example, returning to FIG. 1, handle26 is tilted off axis from parallel alignment with body 30 of controlmember 20. In combination with the location of trigger 28, theorientation of handle 26 provides for easy right-handed use of thecontrol member 20.

An embodiment can include two control members 20 mounted on a frame andoriented for left and right handedness, respectively, for simultaneoususe. For example, a user may wish to control a first tool 10 with theright hand while controlling a second tool 10 with the left hand.Orienting one handle for left-hand use and the other handle forright-hand use gives the user greater flexibility and comfort when usingthe tools.

Various tools described herein can provide ambidextrous use bypermitting changing handedness. In one aspect, the tool handle can bechanged between left-handed and right-handed. In another aspect, theuser can switch the orientation of a tool on-the-fly. By doing so, theuser can operate multiple combinations of tools with either hand duringa single procedure. FIGS. 9A through 9K illustrate a few exemplaryimplementations of this feature. However, the teachings of FIGS. 9A-9Kcan also apply to other handle embodiments described herein.

A first type of ambidextrous handle detaches from the control mechanismto permit a change in handedness. For example, the handle can bedetached and flip upside down to change handedness. FIGS. 9A through 9Cillustrate this concept with a tool similar to the one described withreference to FIG. 1. FIG. 9A presents the handle in a right-handedconfiguration. The handle 269 includes a first side 269 a facing up anda second side 269 b facing down. Each of the first and second sides 269a, 269 b can includes mating features 339 for mating with the controlstem 320. In this configuration, the trigger is positioned activation bya user's right hand index finger.

FIG. 9B illustrates handle 268 detached from stem 320 and flipped overinto a left-handed orientation. The first side 269 a now faces downward,while the second side 269 b faces upward. The mating feature 339 on thefirst side 269 a also faces-downward, allowing the handle to mate withstem 320.

FIG. 9C illustrates handle 268 in the final mounted left-handedconfiguration. In this configuration, trigger 28 is positioned foractivation by the index finger of the user's left hand.

The mating features 339 for engaging and disengaging the handle cancomprise, for example, a variety of mechanical and frictional matingfeatures. In one embodiment, the mating feature is an opening in forreceiving a portion of stem 320. In another aspect, the opening extendsfrom the top of the handle 267 to the bottom. The mating feature canalso comprise a protrusion that mates with an opening in the shaft orcontrol body. In still another embodiment, the two mating features 339are located on the same side of the handle 267 grip, but allow forattaching with the stem 320 in order to suit different handedness.

A second type of ambidextrous handle is illustrated in FIGS. 9D and 9E.Unlike the previous type, the handle 266 can change the orientation oftrigger 281 via rotating handle portion 266 a. In addition, handle 266can change orientation with respect to house 30 of control member 20 viarotation of handle 226 between a right-handed configuration and a lefthanded configuration.

In one aspect, handle 266 includes first and second handle portions 266a and 266 b rotatably connect with one another via pivot 338. rotatinghandle portion 266 a with respect to 266 b, changes the orientation oftrigger 281. In addition, first handle portion 266 b can rotatablyconnect to the stem or control body of the tool. Rotating handleportions 266 a, 266 b together around stem 320 changes the handedness ofhandle 266.

As illustrated in FIG. 9D, the rotatable portion 266 a can include apush-pull mechanism 281 oriented for right-handed use. The push-pullmechanism 281 is a trigger that operates much like a scissor, and allowsthe user to control an end effector and/or actuate a catheter. Forexample, the push-pull mechanism 281 can push or pull a cable that runsthrough a hole in pivot 338, and down the stem 320 into the body of thecontrol device.

By rotating both handle portions 266 a and 266 b by 180 degrees, asdescribed above, the user effectively flips the push-pull mechanism 281to a different handedness. FIG. 9D includes a stem axis (axis S-S) andhandle axis (axis H-H) for further clarity. The first portion 266 b andsecond portion 266 a rotate around the stem axis, while the secondportion 266 a also rotates around the handle axis. As a result, thefirst portion 266 b and the second portion 266 a switch sides, as shownin FIG. 9E. The orientation of the trigger 281 also reverses because itis attached to the first portion 266 a.

To allow for rotating the sections to change handedness, the handle 266includes two switches 291 and 292 for locking/unlocking both handleportions. Switch 291 locks and unlocks the rotatable portion 266 a fromswiveling at the pivot 338 with angling portion 266 b engaging anddisengaging a first mating structure (not pictured). Switch 292 locksand unlocks the angling portion 266 b of the handle 266 from the stem320 by engaging and disengaging a second mating structure (notpictured). Potential mating structures include a tooth, pin, clamp,detent system, strap, or any other known structure for mechanicallylocking and inhibiting movement between two members.

In another embodiment, both portions 291 and 292 are unlocked with asingle switch. As used herein, the switch can include a slide, button,or any other locking mechanism, such as a pin or screw.

The user can adjust the handle 266 to a more comfortable orientation inone embodiment by rotating the appropriate portion 266 a and/or 266 b.For example, the user can rotate the push-pull mechanism 281 upwardsand/or manipulating the horizontal orientation of the handle grip. Whenthe user positions the handle 266 as desired, the portions 266 a and 266b are locked in place.

A third type of ambidextrous handle, shown in FIG. 9F, can changehandedness by rotating in only one plane. FIG. 9F illustrates a handle269 that is round and contains a switch 284 in the form of a button. Asillustrated, the handle 269 has a left-handed configuration, wherein theuser controls switch 284 with their left thumb.

To change the handedness, handle 269 rotates relative to the controlbody 30 or stem 320. Switch 292 unlocks the handle 269 for rotation. Inone embodiment, unlocking does not detach the handle 269 from the stem320 or control body 30, but instead allows the handle 269 to rotatearound the stem 320. In another embodiment, the handle 269 remainslocked to the stem 320, but the handle 269 and stem 320 rotate together,relative to the control body 30. Similarly, in embodiments where no stem320 exists, rotation may occur around some other axis, such as axis S-S.Even in embodiments that include a stem 320, such as FIG. 9F, rotationneed not necessarily occur around an axis through the stem. For example,the handle 269 in FIG. 9F could alternatively rotate around axis S-S.

In an embodiment that accomplishes ambidexterity through this rotationalapproach, a single opening 339 can suffice for mating with the controlstem.

FIGS. 9G through 9L illustrate some alternate handle embodiments thatimplement the rotational and detachable characteristics of handlesalready described. Some of these embodiments implement additionalcharacteristics, such as a joystick configuration option.

FIG. 9G illustrates an ambidextrous handle 267 with a push-pullmechanism 281 (another type of trigger). The push-pull mechanism 281pushes and pulls the inner-filament of cable 346, which transfers forcesfrom the handle 267 to the end effector. As shown in FIG. 9G, the cablecan exit the handle 267 from a first exit point 347 a in one embodiment,or a second exit point 347 b in another embodiment. An exterior cableallows the user to detach and flip the handle 267 even though handle 267includes a trigger. In one embodiment, the trigger 281 can still be usedwhen handle 267 is detached.

In one embodiment, the cable 346 passes through a firewall (such asdescribed with reference to FIGS. 2H and 2I). Conversely, in anotherembodiment, the cable 346 passes directly from the handle to thearticulation section of the catheter, without the use of the firewall.

FIG. 9G also illustrates an exemplary alternative cautery connection 348for use in cauterization procedures. Of course, other embodiments do notimplement this feature but still use the handle 267 shown in FIG. 9B.

FIG. 9H illustrates a handle 268 that can change handedness by eitherdetaching and flipping or by simply rotating relative to the stem.Because the trigger 282 and handle 268 can conform to either handwithout being flipped vertically, rotating the handle with respect thestem reorients the handle. Similarly, flipping the handle verticallyalso switches the handedness.

The handles 268 illustrated in FIGS. 9I through 9L provide even furtherflexibility by providing an additional opening 349 to allow the user tostand the handle on end in joystick configuration. The user may,therefore, select to operate the handle 268 with the grip laying flat byconnecting the handle at opening 339, or as a joystick by connecting tothe stem at opening 349. As previously described, switch 292 locks andunlocks the handle 268 from the control stem.

FIG. 9k illustrates a handle 268 that includes a mating feature 349′ atthe bottom of a rounded boss. This mating feature puts the handle 268 inpistol grip configuration, which is another type of joystickconfiguration. Handle 268 also includes an alternate mating feature 349for yet another joystick configuration.

FIG. 9L illustrates an ambidextrous handle 268 that can be flipped fororientation with either hand, and, alternatively, stood on its end in ajoystick configuration.

The illustrated handle 268 includes a rocker mechanism 283, which is yetanother type of trigger. The rocker mechanism 282 allows a user toarticulate the end effector and/or articulation section of a catheter byperforming a rocking motion. Rather than swinging outward like ascissor, the rocker mechanism 282 incorporates a see-saw action, suchthat pushing one side down forces the other side up. The rockermechanism 282 can be spring-loaded for returning to a home position.Conversely, in another embodiment, the rocker remains in its lastposition until adjusted by the user.

The Catheter

Further described herein are alternative configurations of the catheter.In one aspect, catheter 221 includes body 90 configured to provideincreased torsional strength. As shown in FIGS. 10A through 10C,catheter 221 can include a continuous body section having cut-outs 92 topermit (or ease) flexing and/or bending. The catheter includes a seriesof opposing cut-out sections 92 a, 92 b (FIG. 10B) with each pair ofopposing cut-outs adjacent another pair of opposing cut-outs 92 c, 92 d(FIG. 10B, 92 d not illustrated) positioned at an angle with respectthereto. In one aspect, adjacent cut-out pairs are offset by about 90degrees. In particular, side cut-out pairs 92 c, 92 d are positionedadjacent to top-bottom cut-out pairs 92 a, 92 b. The cut-outs permitbending while the remaining body between the cut-outs can transfertorsional loads.

In another embodiment, catheter 222 can transmit torsional loads viamechanical interlocks between adjacent catheter body segments. FIGS. 11Athrough 11C illustrate segments 120 having articulating mechanicalinterlocks 122. The interlocks allow pivoting but do not allow rotationand/or translation of the segments with respect to one another. In otherwords, the mechanical interlocks limit at least one degree of freedombetween adjacent catheter body segments 120.

In one aspect, mechanical interlocks 122 include a male-femaleconnection that permits only one degree of freedom. For example, malemating member 124 can have an elongate, curved outer surface that isreceived in an elongate female mating member 126 having a correspondingshape. While interlocked, the male mating member can pivot within thefemale mating member along an axis parallel to the elongate male andfemale mating members. However, the male-female interlock can inhibitpivotal movement on other axes. In addition, the male-female interlockcan inhibit relative rotational, longitudinal, and/or transversemovement between the adjacent segments.

For example, with respect to segments 120 a, 120 b (FIG. 11A) themechanical interlocks permit up-down pivoting, but not side-to-sidepivoting. Conversely, adjacent segment 120 c can pivot side-to-side withrespect to segment 120 a, but the mechanical interlock between segments120 a and 120 c prevent up-down pivoting. Taken together, the segmentsof catheter 222 permit up-down and side-to-side articulation, butinhibit at least rotational movement between the segments. In this way,the segments maintain torsional integrity throughout the length ofcatheter 222.

FIG. 11B shows a close-up side view of a ball socket (e.g., mechanicalinterlock). The socket of segment 120 a holds the curved member ofsegment 120 b in place by extending past the center point 124′ of thecurved member. In this way, the socket wraps more than half way aroundthe curved member. As a result, the width of the socket opening 125 b isless than the greatest diameter of the curved member 125 a.

In addition, the curved member can be held in place laterally by theincorporation of one or more stops. For example, a the socket can havean inner wall that contacts the side of the curved member. In oneembodiment, the contacted inner side of the curved member is flat.Providing an inner wall on the matching socket at the other side of thesame segment can prevent the connected segment from sliding looselaterally. Alternatively or in addition, a stop can exist on the outerside of the curved member. The outer stop can also integrate with thesocket in one embodiment.

An over sheath can also prevent slippage or separation of the segments102 a and 120 b. The over sheath may be an elongate bendable layer thatsurrounds the exterior of the segments. In addition to holdingproperties, the over sheath can prevent pinching when the catheterarticulates.

In one embodiment, the segments include one or more holes 128 forreceiving a cable. The holes 128 of each segment align such that thecable can be threaded through multiple sections over an articulationsection. When the cable is pulled from the proximal end of the catheter,such as by the control mechanism, the segment(s) bend within thearticulation section. In one embodiment, the articulation section canbend in multiple directions (e.g., left/right, up/down).

In another embodiment, the articulation section is comprised of at leastone bendable and torque stable segment. While the segment(s) can bearticulated from side to side and front to back, they remainrotationally rigid so that the end effector better withstands torsionalforces.

FIGS. 12A through 12E illustrate another embodiment of a catheter 223utilizing mechanical interlocks for at least one degree of freedom. InFIG. 12A, the catheter includes an articulation section 155 and a rigidsection 154. When a user manipulates the handle of tool 10, andarticulates the catheter 223, articulation occurs along the articulationsection 155. The articulation section includes multiple joint segmentsmechanically interlocked via entrapping balls 153. Cables 133 or otherstructures apply the tension to flex the articulation joints. An over,braid or other sheath covers the articulation joints to prevent pinchingwhen the articulation joints flex.

FIG. 12B shows this arrangement in detail. The articulation section 155begins with a first joint segment 152 a interlocked with a second jointsegment 152 b. The entrapping ball 153 fits within a socket pivot pointin second joint segment 152 b. By repeating this arrangement down thelength of the articulation section 223, a chain of joint segments allowtorque transfer from one segment to another. As a result, thearticulation section achieves at least one degree of freedom.

In one embodiment, such as shown in FIG. 12C, the joint segments have arecess or opening defining a passageway. Through this passageway, one ormore push-pull cables, electrical cables, lumens, and/or other tubingcan access the end effector. In another embodiment, the joint segmentsare divided into quadrants.

While the articulation joints of FIG. 12E allow only side-to-sidemovement of the articulation section 223, FIG. 12D depicts multiplejoint segments interlocked via entrapping balls 156 a and 156 b thatallow for movement in two different planes. The articulation jointsillustrated in FIG. 12D alternate in type. For example, segment 157 aincludes two entrapping balls 156 a and 156 b, one on each side, formovement in two separate planes. Conversely, the next segment 157 bcontains no entrapping balls but has two mating sockets, one on eachside, for connecting with the entrapping balls in two different planes.

The catheter can be driven by user inputs. These inputs drive thearticulation section in one embodiment. In another embodiment, portionsof the catheter other than the articulation section can also be driven.Articulation does not require bending separate parts. Instead, it morebroadly refers to the bending of the body as a whole.

The articulation section of FIGS. 12A through 12E can be constructed bymicro-welding the segments together. Entrapping the ball and socketreduces the chances of segments slipping loose from one another, andalso provides a low cost articulation section because other parts arenot necessarily required. Preferably, each socket entraps the ball formore than 180 degrees, as shown in FIGS. 12A through 12E.

FIGS. 12F and 12G illustrate another type of ball socket system. Curvedmember 153 snaps into a socket. Thus, the catheter can be constructedfrom snapping together the segments. In addition, the segment bodyprovides inner stops to keep the segments from sliding laterally.

FIGS. 13A through 13D illustrate yet another type of articulation jointfor use in a catheter. FIG. 13A shows the cross section of a continuousstructure 225 (or series of structures), which forms a cross shape,dividing the inside of the catheter into four quadrants 165 a, 165 b,165 c, and 165 d. The quadrants can define lumens or channels within thecatheter for the passage of control cables, medical devices, and/orfluids. Eyelets 166 along the periphery of the structures receivecontrol cables for articulating the catheter.

The articulation segments of FIGS. 13A to 13D are fixedly mated with oneanother and/or formed of a single, continuous structure 225 (or seriesof structures) that bends at hinges 167 a and 167 b. In one aspect,hinges 167 a, 167 b are defined by living hinges. For example, areas ofthin cross-section allow bending between adjacent segments and definethe individual segments. The articulation joint materials and hingeconstruction (e.g., thickness) can be selected based on the desiredforce-to-bend ratio for the catheter. Suitable-materialsfor-constructing-the articulation joints include stainless spring steel.Possible fabrication methods include precision stamping strips of metalor laser cutting the metal and then micro welding the strips together.

The degrees of freedom are controlled based on the position of thehinges within body 164. In one aspect, each hinge only allow for bendingin one plane with adjacent hinges offset from one another. For example,a first hinge 167 a can permit up/down movement, while a second hinge167 b can permit left/right movement. The shape segments and/or thehinges can control maximum bending limits for the catheter. For example,to restrict bending, the space 169 between adjacent segments can benarrowed.

A multidirectional hinge is also possible if the continuous structure225 is thin in both planes at point 168.

FIGS. 14A through 14E illustrate another embodiment of tool 10 includinghydraulic control of at least one degree of freedom. In one aspect,catheter 223 includes at least one fluid pathway that can receive ahydraulic fluid (e.g., generally any fluid and not necessarily“industrial” hydraulic fluids) to control one degree of freedom. Inanother aspect, two fluid pathways can be formed in catheter 223. Asshown in FIG. 14A, device 10 can include two fluid actuators 130 a, 130b, each fluid actuator corresponding to two fluid pathways 132 a, 132 band 132 c, 132 d, respectively. The fluid actuators 130 a, 130 b candeliver and withdraw fluid to cause expansion of the volume of at leastone of the fluid pathways and thereby cause catheter 223 to bend.

For example, when a piston head 131 a of fluid actuator 130 a is pressedinward and moves distally within fluid actuator 130 a, the piston head131 a forces fluid out of the fluid actuator 130 a and into fluidpathway 132 a. While the amount of fluid in the fluid actuator 130 a onthe distal side of the piston head 131 a decreases, the amount of fluidin the fluid pathway 132 a increases. Simultaneously, this piston head131 a movement draws fluid out of fluid pathway 132 b, and into fluidactuator 131 a on the proximal side of piston head 131 a.

FIG. 14B illustrates a cross-sectional view of one exemplary aspect ofcatheter 223. Each fluid pathway 132 a, 132 b, 132 c, 132 d can bepositioned in different quadrants of the catheter. When the volume offluid within one of the fluid pathways increases, the length of theportion of catheter which the fluid pathway occupies will increasecausing the catheter to bend. Similarly, withdrawing fluid will cause areduction in the length of one side of the catheter 223 and a bendingtoward the reduced-volume fluid pathway.

Alternatively, as illustrated in FIGS. 14C through 14E, catheter 223 canhave a configuration similar to the catheter illustrated FIGS. 9Athrough 9D. The cut-outs 92 in catheter 223 can define a portion offluid pathways 132 a, 132 b, 132 c, 132 d such that increasing thevolume of fluid in a pathway causes the longitudinal length of thecut-out to increase. In one aspect, cut-outs 92 a, 92 b, 92 c, and 9 dare fluidly sealed. For example, as illustrated in FIG. 14C, an outersheath 136 can enclose the body 138 of catheter 223 and cut-outs 92.When the cut-outs increase in size or volume, outer sheath 136 canstretch allow catheter 223 to bend.

In another embodiment, the shapes of inflated fluid pathways 132 a, 132b, 132 c, and 132 d can be formed to affect the bending of thearticulation section of catheter 223. As fluid fills a particularpathway, the pressure forces the articulation section of catheter 223 toconform to the shape of that fluid pathway. A user can use thisembodiment to lock the catheter 223 into a particular curved shape, forexample.

While catheter 222 is illustrated as having expandable fluid pathways(or cut-outs) along its whole length, in another aspect, only a portionof the catheter is articulating (i.e., the articulation section). Forexample, a distal portion of the catheter 223 can include cut-outs orfluidly expandable chambers or pathways to permit articulation.

One skilled in the art will appreciate that the degree of articulation(i.e., the amount of bend) can be varied depending on the amount ofhydraulic pressure applied and/or on the material of catheter 223, thesize of the fluid pathway, the shape of the fluid pathway, and/or thelocation of the fluid pathway.

Regardless of the configuration of the fluid pathways, catheter 223,like the catheters described above, can include at least one channel forthe passage of at least one medical tool. For example, as illustrated inFIGS. 14B and 14C, channel 134 is positioned along the centrallongitudinal axis of the catheter and is surrounded by fluid pathways132 a, 132 b, 132 c, 132 d. Channel 134 can serve as a lumen or multiplelumens in other embodiments.

Other embodiments will be apparent to those skilled in the art fromconsideration of the specification and practice of the embodimentsdisclosed herein. It is intended that the specification and examples beconsidered as exemplary only, with a true scope and spirit of theembodiments being indicated by the following claims.

A variety of alternative control members, which allow a distal end oftool 40 to be actuated in the up/down, right/left, forward/backward, androtational directions, can be used with system 20. Such alternativecontrol mechanisms are disclosed, for example, in U.S. patentapplication Ser. No. 11/165,593, entitled “Medical Device ControlSystem” and U.S. patent application Ser. No. 11/474,114, entitled“Medical Device Control System,” both of which are hereby incorporatedby reference in their entirety.

The invention claimed is:
 1. A medical system comprising: a controlmember including a body and a handle coupled to the body via a shaft,wherein the handle is rotatable relative to the body about a first axisand a second axis different than the first axis, and a longitudinal axisof the shaft defines the first axis or the second axis; a plurality ofcontrol cables including a first control cable, a second control cable,and a third control cable; a first disk coupled to the second controlcable; a second disk coupled to the third control cable; and a catheter;wherein the shaft extends through an aperture of each of the first diskand the second disk; wherein rotating the handle about the first axistensions the first control cable to deflect a distal tip of the catheteralong a first plane; and wherein rotating the handle about the secondaxis in a first direction tensions the second control cable withouttensioning the third control cable to deflect the distal tip of thecatheter in one direction along a second plane, and rotating the handleabout the second axis in a second direction tensions the third controlcable without tensioning the second control cable to deflect the distaltip of the catheter in another direction along the second plane.
 2. Themedical system of claim 1, wherein rotating the handle clockwise aboutthe second axis tensions the second control cable without tensioning thefirst control cable or the third control cable, and rotating the handlecounterclockwise about the second axis tensions the third control cablewithout tensioning the first control cable or the second control cable.3. The medical system of claim 1, wherein the handle is coupled to atrunnion.
 4. The medical system of claim 3, wherein the trunnionincludes posts that define the first axis.
 5. The medical system ofclaim 1, wherein the first disk is a pulley comprising a groove thatreceives the second control cable.
 6. The medical system of claim 1,wherein the first disk includes a rut, and tensioning of the secondcontrol cable is driven by engaging a pin with the rut.
 7. The medicalsystem of claim 1, wherein the body of the control member includes alocking element that inhibits or prevents rotation of the catheterrelative to the control member when the locking element is engaged withthe catheter.
 8. The medical system of claim 1, wherein the handleincludes a trigger that actuates an end effector at a distal end of thecatheter, the trigger being coupled to the end effector by a fourthcontrol cable.
 9. The medical system of claim 1, wherein the first diskis parallel to the second disk.